Retrospective assessment of childhood sexual and physical abuse: a comparison of scaled and behaviorally specific approaches

Comparison of childhood trauma between depressive disorders and personality disorders

The relationship between childhood trauma with major depressive disorder (MDD) and personality disorders is complex. We explored the differences in the subjective reporting of childhood trauma to determine whether there were differences between those with a diagnosis of personality disorder and those with MDD. Adult patients with depressive symptoms were recruited from three adult psychiatry inpatient wards. Sixty inpatients fulfilled the study criteria and were requested to complete the childhood trauma questionnaire (CTQ). At discharge, diagnosis was determined and was allocated mainly to two groups: those with MDD and those with personality disorder. Those with MDD, dysthymia and subsyndromal depressive symptoms were included in the Depression Broad Definition (DBD) group (secondary analysis). Significantly higher subjective reporting of childhood trauma was observed in the personality disorder group compared with MDD in three CTQ domains. Similarly, significantly higher reporting of childhood trauma was observed in all five CTQ domains in those with a personality disorder compared with the DBD group. In conclusion, the presence of personality disorder was associated with greater subjective reporting of childhood trauma compared with those with MDD, and further research is required to explore the differences in objective experience of childhood trauma between the diagnoses using objective measures.

"I Am A Living Testimony to the Human Spirit": A Thematic Analysis of Middle Aged and Older Adults' Resilience after Child Sexual Abuse

Despite extensive documentation of the adverse impacts of child sexual abuse (CSA), less is known about long-term effects of CSA, that is, the impact in middle and late adulthood, when one is further removed from the CSA. This study describes coping strategies and positive outcomes reported by adult female survivors of child sexual abuse ages 50+ (n = 58). Responses came from an anonymous online survey of adult survivors of CSA. We conducted a qualitative "RADaR" rapid analysis on the survey's open-ended questions. Survivors employed both internal attitudes and specific activities to cope with their childhood CSA. Most (n = 55) reported positive outcomes from CSA: self, others, and relational and/or emotive strengths. Due to survey limitations, we were unable to identify factors that contributed to survivors reporting positive outcomes and survivors who reported negative or no positive outcomes. This study suggests CSA survivors in middle and late adulthood may feel stronger as a result of abuse. More research is needed to identify factors that contribute to resilience.

The Effect of Child Trauma on the Relation between Psychological Well-Being and Depressive Symptoms in Chilean University Students

(1) Background: There is consistent evidence of the impact of early adverse experiences on mental health in adulthood, especially as a risk factor for depression. However, their influence on positive aspects of mental health such as well-being has been less extensively studied. Therefore, this study aims to investigate the effect of traumatic childhood experiences on the relationship between depression and psychological well-being in a sample of university students. (2) Methods: The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Beck Depression Inventory (BDI-IA), and Ryff's psychological well-being scale were administered to 700 Chilean university students. Several regression models were used to analyze the interaction between variables, with multivariate SEM being applied to hierarchize the relationships found. (3) Results: Emotional Neglect and Abuse stand out as the types of maltreatment with the greatest impact on mental health, associated first with a decrease in the self-acceptance dimension of psychological well-being and then with depressive symptomatology in adulthood. (4) Conclusions: Results provide evidence that early trauma has an important impact on mental health, increasing the risk of depression, however, its impact is greater on positive aspects of health, such as self-acceptance, a fundamental element in the construction of psychological well-being.

An Experimental Test of the Impact of Varying Questionnaire Response Format on Prevalence Rates for Sexual Violence Victimization and Perpetration

OBJECTIVE

This study examined the impact of a dichotomous versus scaled response format on prevalence rates of sexual violence perpetration and victimization, thus conceptually replicating Hamby et al., 2006 and extending those findings to the context of sexual violence.

METHODS

Two samples were recruited from Amazon Mechanical Turk and were randomly assigned to either a dichotomous or scaled response format of the same questionnaire. Sample 1 was used to examine perpetration and received a perpetration specific version of the Post-Refusal Sexual Persistence Scale (PRSPS). Sample 2 was used to examine victimization and received a victimization specific version of the PRSPS.

RESULTS

Men and women who received the scaled response format reported significantly more incidents of sexual perpetration, and for each type of tactic studied, on the order of 1.7-9x more frequently. The association between response format condition and prevalence rates of sexual violence victimization was significant only for men (23.0 vs 39.4%) and for the tactic of verbal coercion (30.1 vs 41.5%), with the scaled response format producing greater responding.

CONCLUSIONS

The response format of sexual violence items can significantly alter prevalence rates of sexual violence perpetration, with scaled response formats producing greater endorsements than dichotomous formats. Response format also appears to impact prevalence rates of sexual violence victimization, particularly for men.

Are Affective Temperaments, Emotional Abuse, and Neglect Involved in Mentalization Abilities in Patients With Psychiatric Disorders?

Patients who have experienced emotional abuse and neglect often develop psychiatric disorders in adulthood. However, whether emotional abuse, neglect, and mentalization abilities relate to one another and the role of possible mediators of this relationship in psychiatric patients are still unknown. We evaluated the potential role of affective temperament as a mediator of the relationship between emotional abuse and neglect and mentalization. We performed a cross-sectional study of 252 adult psychiatric inpatients. The Childhood Trauma Questionnaire, Mentalization Questionnaire, and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) were administered. Results showed a significant indirect effect of emotional abuse and neglect on scores on the Mentalization Questionnaire through the TEMPS-A (b = 0.25, 95% confidence interval [0.143-0.375]), demonstrating that affective temperament mediates the relationship among emotional abuse, neglect, and mentalization impairment in psychiatric patients. A careful evaluation of mentalization abilities in patients with psychiatric disorders and who have a history of emotional abuse and neglect is necessary for a better understanding of psychopathology and for the choice of therapeutic strategies.

Lessons Learned: Creation and Testing of a New Instrument (Sex Offenders Grooming Assessment) for Measuring Sex Offenders' Perceptions of Their Grooming Behaviors

Grooming is a process whereby an individual who plans to commit a sexual crime uses deception with the victim as well as the people in the environment (such as the victim's family members, the offender's family, etc.) so that the crime goes undetected. Despite the overwhelming presence of grooming in sexual crimes, there is a dearth of research on sex offenders' perceptions of their own grooming behaviors. This paper describes the psychometrics and lessons learned in the pilot study of testing and revising a new instrument for measuring sex offenders' perceptions of their grooming behaviors (Sex Offenders Grooming Assessment; SOGA), with a sample (n = 50) of convicted male sex offenders in community based specialized therapy. Analyses suggest that using behaviorally-specific questions yielded more reliable results than general categorical grooming questions. Understanding how sex offenders perceive and report their grooming behavior provides valuable insight critical to treatment and assessment.

Altered basal forebrain BOLD signal variability at rest in posttraumatic stress disorder: A potential candidate vulnerability mechanism for neurodegeneration in PTSD

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for the development of various forms of dementia. Nevertheless, the neuropathological link between PTSD and neurodegeneration remains unclear. Degeneration of the human basal forebrain constitutes a pathological hallmark of neurodegenerative diseases, such as Alzheimer's and Parkinson's disease. In this seed-based resting-state (rs-)fMRI study identifying as outcome measure the temporal BOLD signal fluctuation magnitude, a seed-to-voxel analyses assessed temporal correlations between the average BOLD signal within a bilateral whole basal forebrain region-of-interest and each whole-brain voxel among individuals with PTSD (n = 65), its dissociative subtype (PTSD+DS) (n = 38) and healthy controls (n = 46). We found that compared both with the PTSD and healthy controls groups, the PTSD+DS group exhibited increased BOLD signal variability within two nuclei of the seed region, specifically in its extended amygdaloid region: the nucleus accumbens and the sublenticular extended amygdala. This finding is provocative, because it mimics staging models of neurodegenerative diseases reporting allocation of neuropathology in early disease stages circumscribed to the basal forebrain. Here, underlying candidate etiopathogenetic mechanisms are neurovascular uncoupling, decreased connectivity in local- and large-scale neural networks, or disrupted mesolimbic dopaminergic circuitry, acting indirectly upon the basal forebrain cholinergic pathways. These abnormalities may underpin reward-related deficits representing a putative link between persistent traumatic memory in PTSD and anterograde memory deficits in neurodegeneration. Observed alterations of the basal forebrain in the dissociative subtype of PTSD point towards the urgent need for further exploration of this region as a potential candidate vulnerability mechanism for neurodegeneration in PTSD.

Prevalences of and correlations between childhood trauma and depressive symptoms, anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam

OBJECTIVES

We investigated the prevalence rates of childhood trauma, depressive symptoms, anxiety symptoms and suicidal behaviors among Vietnamese adolescents and compared the differences between institutionalized adolescents (IAs) and noninstitutionalized adolescents (NIAs). In addition, we examined the multidimensional associations between childhood trauma and psychopathology among IAs.

METHODS

Five hundred forty-six participants were recruited into two groups (IAs and NIAs) matched by age, sex and grade. They completed a childhood trauma questionnaire, depression scale, anxiety scale, and 3 suicide-related questions. The chi-squared test and logistic regressions were performed.

RESULTS

The prevalences of anxiety symptoms and suicide attempts among IAs was higher than that among NIAs (25.6 % vs 14.7 %, p = 0.001 and 8.1 vs 3.7, p = 0.03, respectively), while the prevalences of other psychopathologies did not differ significantly. In the IA group, high prevalences of victimization through physical abuse (22.3 %), emotional neglect (57.9 %), and physical neglect (72.9 %) were found, and 58.6 % of the participants had experienced more than one type of trauma. These figures were significantly higher in IAs than in NIAs. Depression and suicidal ideation were more strongly correlated with emotional abuse and neglect than other types of maltreatment, while anxiety, suicide planning and suicide attempts were more strongly correlated with physical abuse. IAs who experienced more than two categories of trauma or greater intensity of trauma were more susceptible to developing depression, anxiety, and suicidal behaviors.

CONCLUSIONS

Childhood trauma was multidimensionally associated with adverse psychological outcomes. We suggest that various aspects of childhood trauma, as well as psychopathologies, must be routinely assessed.

An Initial Test of the Tactic-First and Item-Order Hypotheses: Accounting for Response Discrepancies in Sexual Victimization Questionnaires

Reported prevalence rates of sexual violence range widely in the literature, even in the same sample when using two different questionnaires of the same construct. These discrepancies are concerning as they indicate we may be underestimating the rate of sexual violence and, therefore, resources and treatment for victims. Thus, the current study aimed to investigate two mechanisms that may contribute to differences in reported prevalence rates across the literature and discrepancies within studies: the tactic-first and item-order hypotheses. Participants were 265 MTurk workers whom all completed the Post-Refusal Sexual Persistence Scale (PRSPS), then were randomly assigned to one of two versions of a tactic-first Sexual Experiences Survey (T-SES). Experimental conditions varied in the item order of the T-SES, one condition received the traditional hierarchical item order (n = 130) while the other received a randomized item order (n = 135). Our results suggest strong support for the tactic-first hypothesis; victimization prevalence rates on the T-SES were double compared to the traditional SES (54.1 vs. 19.8%) in prior research. Further, in both conditions, victimization prevalence rates were statistically equivalent between the PRSPS (62.6%) and the tactic-first SESs (56.2 and 54.1%), χ²(1) < 2.5, p ≈ .1 -.7, contrary to prior research. We did not find support for the item-order hypothesis; there were few differences between item-order conditions. Our findings indicate that unintentional underreporting remains a threat to validity in sexual violence assessment, and continued research into the mechanisms of measurement is warranted.

Discrepant Responding across Measures of College Students' Sexual Victimization Experiences: Conceptual Replication and Extension

Sexual violence victimization affects approximately 1 in 5 college women and 1 in 6 college men; however, rates of sexual victimization vary widely, in part due to measurement issues. The present study is the first to compare the Sexual Experiences Survey-Short Form Victimization (SES-SFV) to a measure of sexual victimization designed to capture gender differences, the Post-Refusal Sexual Persistence Scale-Victimization (PRSPS-V). Prior research has compared the perpetration versions of these questionnaires and found large discrepancies. College students (N = 673: 367 women, 298 men, 8 gender minority) were surveyed. The SES-SFV identified 260 cases of sexual victimization whereas the PRSPS-V identified 330 cases; this discrepancy was largest for men. While percent agreement between the two measures ranged from 79.9-92.0%, kappa estimates indicated that agreement was in the weak to moderate range. Kappa estimates tended to be poorer for men than women. These results highlight poor precision in the measurement of sexual violence victimization, even when using well-established measures. The PRSPS-V identified more cases and may be less gender biased. We discuss how differences in questionnaire structure, item structure, and operationalization of consent may account for discordance between the SES-SFV and PRSPS-V even when controlling for item content.

Effect of child abuse and neglect on risk behaviors in inner-city minority female adolescents and young adults

BACKGROUND

Over six million children each year are referred to child protective services for child abuse (sexual, physical and emotional) and neglect (physical and emotional).

OBJECTIVE

While the relationship between child sexual abuse and sexually transmitted infections has been documented, there has been little research regarding the effects of other forms of maltreatment.

PARTICIPANTS AND SETTING

882 inner-city females aged 12-20 years of age seen at a large adolescent and young adult (AYA) health center in New York City between 2012-2017.

METHODS

History of maltreatment was assessed using the Childhood Trauma Questionnaire. Associations with depressive symptoms, antisocial behavior, peer deviancy, drug/alcohol use, and risky sexual behaviors were assessed.

RESULTS

History of maltreatment was common in our cohort of inner-city AYA females, with 59.6 % reporting any type of maltreatment, including sexual abuse (17.5 %), physical abuse (19.5 %) or neglect (26.2 %), and emotional abuse (30.7 %) or neglect (40.4 %). We observed significant associations between all forms of maltreatment and risk of depression, drug/alcohol use, antisocial behaviors, peer deviancy, and risky sexual risk behaviors (including having a higher number of sexual partners, having a sexual partner 5+ years older, and anal sex). Physical and emotional abuse were associated with having unprotected sex while under the influence of drugs/alcohol.

CONCLUSIONS AND RELEVANCE

Reporting a history of maltreatment was associated with an increased likelihood of engaging in risky sexual and antisocial behaviors, as well as depression in inner-city female youth. These data highlight the broad, lingering repercussions of all types of child maltreatment.

Statistical Approaches for Highly Skewed Data: Evaluating Relations between Maltreatment and Young Adults' Non-Suicidal Self-injury

Objective: Clinical phenomena often feature skewed distributions with an overabundance of zeros. Unfortunately, empirical methods for dealing with this violation of distributional assumptions underlying regression are typically discussed in statistical journals with limited translation to applied researchers. Therefore, this investigation compared statistical approaches for addressing highly skewed data as applied to the evaluation of relations between child maltreatment and non-suicidal self-injury (NSSI). Method: College students (N = 2,651; 64.2% female; 85.2% nonwhite) completed the Child Abuse and Trauma Scale and the Functional Assessment of Self-Mutilation. Statistical models were applied to cross-sectional data to provide illustrative comparisons across predictions to a) raw, highly skewed NSSI outcomes, b) natural log, square-root, and inverse NSSI transformations to reduce skew, c) zero-inflated Poisson (ZIP) and negative-binomial zero-inflated (NBZI) regression models to account for both disproportionate zeros and skewness in the NSSI data, and d) the skew-t distribution to model NSSI skewness. Results: Child maltreatment was significantly and positively related to NSSI frequency in the raw, transformation, and zero-inflated models, but this relation was negative in the skew-t model. Conclusions: These findings highlight the importance of using zero-inflated models rather than transformation approaches to address data skew. Moreover, whereas the skew-t distribution has been used to model skewed non-clinical data, this study suggests that the skew-t approach may not be well-suited to address skewed clinical data.

In Limbo: Time Perspective and Memory Deficit Among Female Survivors of Sexual Abuse

Child sexual abuse (CSA) is a worldwide phenomenon with negative outcomes for survivors whose lives and well-being are compromised into adulthood, due to the trauma caused by the abuse. As trauma survivors often report time and space disorientation as well as memory deficit, an attempt was made to further understand these functions in female adults CSA survivors. More specifically, we questioned how they recalled their past; how their past experience interacted with their experience of the present; and how the past abuse affected the way that they viewed the future. A total of 50 adult female CSA survivors' open-ended life story interviews were analyzed utilizing Thematic Content Analysis. In relation to time perception and memory deficit, three main themes emerged: Adrift in time and space; disintegration of body, mind and identity; and chaos, exhaustion, and confusion. These themes were discussed from the conceptual perspective of "captured in a distorted time," which is one of the traumagenic constructs of childhood sexual abuse.

Maternal Trauma Exposure and Childhood Anxiety Outcomes: Examining Psychosocial Mechanisms of Risk

The current study aimed to explore the relationship between maternal exposure to various types of trauma and child anxiety outcomes, and to investigate maternal depression and parenting quality as potential mediators of these relationships. Aims were examined within a sample of 185 mother-child dyads who participated in a longitudinal study assessing maternal trauma history, maternal depression, and parenting quality at preschool age (ages 2.5 to 5.5 years), and for whom maternal and secondary caregiver reports of child anxiety were obtained at school age (ages 6 to 11 years). Hypotheses were that (1) maternal exposure to trauma would be positively associated with anxiety levels in offspring and that (2) parenting quality and maternal depression would mediate the relationship between maternal exposure to trauma and child anxiety. Results suggest a direct association between maternal trauma history and child anxiety, as well as indirect associations through parenting quality and maternal depression. These findings are discussed with regard to their implications for the prevention of child anxiety, as well as their implications for the advancement of the literature on intergenerational effects of trauma.

The effects of Toxic Early Childhood Experiences on Depression according to Young Schema Model: A Scoping Review

BACKGROUND

Young Schema Model (YSM) emphasizes Toxic Early Childhood Experiences (TECE) as vulnerability factors to depression. However, the lack of consensus on how to define and measure TECE is likely to have led to inconsistent findings in current literature. This review maps supported and unsupported pathways to depression and measures used.

METHODS

A scoping review was conducted in accordance with the Joanna Briggs Institute protocol to identify primary research studies that examined developmental and maintenance pathways to depression within the YSM framework. 2463 articles were identified with 49 primary research studies selected for inclusion. As a subset of the overall review, this paper focuses on the 14 studies that examined effects of TECE on depression in context of YSM.

RESULTS

The studies used 11 different measures to examine the role of TECE in depression. Effects of maltreatment (i.e., physical abuse, emotional abuse, emotional neglect,) and perceived parenting (i.e., low care, high rejection, high overprotection and/or control, maladaptive parenting styles) on depression are well supported. Effects of sexual abuse and physical neglect on depression are currently inconclusive.

CONCLUSION

In conclusion, findings revealed the inconsistent definition and measurement of TECE (with 11 different measures) in current literature. Findings support the effects of physical abuse, emotional abuse, emotional neglect, low care, high rejection, high overprotection and/or control, and maladaptive parenting styles on depression. Limitations of existing studies include researchers' inconsistent definition and measurement of TECE, under-examined TECE sub-constructs, possible moderating relationships, predominant cross-sectional design, and homogeneous sampling. Limitations of the scoping review include its small number of studies and the absence of evaluation of the measures used. Nevertheless, this review represents the first step in the systematic examination of the empirical basis of YSM and is an important contribution to depression treatment and innovation.

Mothers' History of Child Sexual Abuse and Child Behavior Problems: The Mediating Role of Mothers' Helpless State of Mind

This investigation evaluated a theoretically specified model of associations among mothers' history of child sexual abuse (CSA), a helpless state of mind (SOM) with regard to the mother-child relationship, and increased behavior problems in the next generation. Moreover, we evaluated the moderating influence of child gender on predicted relations between mothers' CSA severity and helpless SOM (i.e., moderated mediation). Participants were 225 biological mother-preschooler dyads (48% female; 46.4% Latinx) drawn from an ongoing, longitudinal study of representation and regulation in child development. Mothers' history of CSA was assessed when their children were 4 years old and emerged as a prominent risk factor in this diverse, high-risk community sample with 40% of mothers reporting contact-based sexual abuse prior to age 18. Mediation analyses revealed a significant indirect pathway from a continuous rating of mothers' CSA severity to increased externalizing behavior problems from ages 4 to 8 in the next generation via mothers' helpless SOM at age 6. Further, this indirect path was significant for mother-daughter dyads, but not for mother-son dyads. This investigation contributes to the neophyte literature on intergenerational CSA effects by revealing the impact of a mother's CSA history on her SOM regarding the mother-child relationship, particularly when parenting daughters. Clinical interventions that enhance survivors' awareness of and reflection on their SOM regarding the parent-child relationship may attenuate intergenerational CSA effects on child adaptation.

Superior colliculus resting state networks in post-traumatic stress disorder and its dissociative subtype

OBJECTIVES

The innate alarm system (IAS) models the neurocircuitry involved in threat processing in posttraumatic stress disorder (PTSD). Here, we investigate a primary subcortical structure of the IAS model, the superior colliculus (SC), where the SC is thought to contribute to the mechanisms underlying threat-detection in PTSD. Critically, the functional connectivity between the SC and other nodes of the IAS remains unexplored.

EXPERIMENTAL DESIGN

We conducted a resting-state fMRI study to investigate the functional architecture of the IAS, focusing on connectivity of the SC in PTSD (n = 67), its dissociative subtype (n = 41), and healthy controls (n = 50) using region-of-interest seed-based analysis.

PRINCIPAL OBSERVATIONS

We observed group-specific resting state functional connectivity between the SC for both PTSD and its dissociative subtype, indicative of dedicated IAS collicular pathways in each group of patients. When comparing PTSD to its dissociative subtype, we observed increased resting state functional connectivity between the left SC and the right dorsolateral prefrontal cortex (DLPFC) in PTSD. The DLPFC is involved in modulation of emotional processes associated with active defensive responses characterising PTSD. Moreover, when comparing PTSD to its dissociative subtype, increased resting state functional connectivity was observed between the right SC and the right temporoparietal junction in the dissociative subtype. The temporoparietal junction is involved in depersonalization responses associated with passive defensive responses typical of the dissociative subtype.

CONCLUSIONS

Our findings suggest that unique resting state functional connectivity of the SC parallels the unique symptom profile and defensive responses observed in PTSD and its dissociative subtype. Hum Brain Mapp 39:563-574, 2018. © 2017 Wiley Periodicals, Inc.

Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood

Youth in the foster care system face considerable challenges during the transition to adulthood. However, there is significant variability within this population. This study uses person-oriented methods and a longitudinal dataset of youth aging out of foster care to examine differences in how subgroups of foster youth fare during the transition to adulthood. We identified four distinct latent classes, consistent with prior person-oriented studies of this population, and validated these classes by examining differences on additional relevant factors at age 17. After establishing these classes, we tested their predictive validity by examining differences in outcomes at age 19 in domains relevant to the transition to adulthood, including education and employment, problem behaviors, and mental health problems. Finally, given the importance of extended foster care in promoting better outcomes, we used survival analysis to prospectively examine whether class membership was associated with differences in the rates at which youth left foster care between ages 17 and 19. One large group of youth exhibited moderate behavior problems and left care quickly, while another large group of resilient youth had favorable outcomes and left care relatively slowly. A small group exhibited considerable behavior and mental health problems, but left care more slowly, and a very small group was characterized by a history of pregnancy. Findings suggest considerable variability in service need among older foster youth. Implications for service provision during the transition to adulthood are discussed.

An analysis of retrospective and repeat prospective reports of adverse childhood experiences from the South African Birth to Twenty Plus cohort

Most studies rely on cross-sectional retrospective reports from adult samples to collect information about adverse childhood experiences (ACEs) to examine relationships with adult outcomes. The problems associated with these reports have long been debated, with only a few studies determining their reliability and validity and fewer still reaching consensus on the matter. This paper uses repeat prospective and retrospective reports of adverse childhood experiences from two respondent sources in the South African Birth to Twenty Plus (Bt20+) cohort to explore agreement and concordance in the prospective reporting of ACEs by caregivers and respective children as adolescents and then as young adults. The findings demonstrate little overall agreement between prospective and retrospective accounts of childhood experiences, with 80% of kappa values below the moderate agreement cutoff (k = .41). The highest levels of agreement were found between prospective and retrospective reporting on parental and household death (kappas ranging from .519 to .944). Comparisons between prospective caregiver reports and retrospective young adult reports yielded high concordance rates on sexual and physical abuse and exposure to intimate partner violence (91.0%, 87.7% and 80.2%, respectively). The prevalence of reported ACEs varied with the age of the respondent, with adolescents reporting much higher rates of exposure to violence, physical and sexual abuse than are reported retrospectively or by caregivers. This variation may partly reflect actual changes in circumstances with maturation, but may be influenced by developmental stage and issues of memory, cognition and emotional state more than has been considered in previous analyses. More research, across disciplines, is needed to understand these processes and their effect on recall. Long-term prospective studies are critical for this purpose. In conclusion, methodological research that uses a range of information sources to establish the reliability and validity of both retrospective and prospective reports ‒ recognizing that the two approaches may fundamentally answer different questions ‒ should be encouraged.

The long-term co-occurrence of psychiatric illness and behavioral problems following child sexual abuse

OBJECTIVES

There is a growing body of research investigating the relationship between child sexual abuse and a range of adverse outcomes. However, very little is known about the long-term co-occurrence of psychiatric disorders and behavioral problems among this vulnerable population, or the interaction between characteristics of the abuse, such as the nature and timing of the child sexual abuse, and the extent of subsequent adversities. This study aimed to determine the rate and co-occurrence of mental health morbidity, criminal justice system contact, and fatal self-harm among medically confirmed victims of child sexual abuse, and to identify abuse variables associated with a greater likelihood of cumulative adverse experiences.

METHODS

The forensic medical records of 2759 cases of child sexual abuse assessed between 1964 and 1995 were linked with public psychiatric, criminal justice and coronial administrative databases between 13 and 44 years following abuse. Cases were compared to 2677 matched comparisons from the general population.

RESULTS

Abuse victims were more likely (odds ratio = 7.2, 95% confidence interval = [4.9, 10.4], p < 0.001) to experience cumulative adverse psychiatric and behavioral problems relative to comparisons. Almost half (47.6%) of victims who died of suicide or drug overdose had a history of offending, further victimization and mental illness. Relative to comparisons, female victims demonstrated the largest increase in odds for cumulative outcomes (odds ratio = 9.8, 95% confidence interval = [5.8, 16.8], p < 0.001), whereas in absolute terms, male victims were at an elevated risk for all types and combinations of adverse outcomes, except fatal self-harm. Boys who were older at abuse, had multiple abuse episodes or who were abused by an extra-familial perpetrator were most likely to experience poorer clinical trajectories. Only being older at abuse was associated with cumulative adverse experiences for females.

CONCLUSIONS

Sexual abuse, particularly during adolescence (ages 12-16 years), appears to be a risk factor for co-occurring adverse experiences. This study identifies particular groups of child sexual abuse victims as at-risk and requiring targeted intervention.

fMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with hyperarousal and active fight or flight defensive responses. By contrast, the dissociative subtype of PTSD, characterized by depersonalization and derealization symptoms, is frequently accompanied by additional passive or submissive defensive responses associated with autonomic blunting. Here, the periaqueductal gray (PAG) plays a central role in defensive responses, where the dorsolateral (DL-PAG) and ventrolateral PAG (VL-PAG) are thought to mediate active and passive defensive responses, respectively.

METHODS

We examined PAG subregion (dorsolateral and ventrolateral) resting-state functional connectivity in three groups: PTSD patients without the dissociative subtype (n = 60); PTSD patients with the dissociative subtype (n = 37); and healthy controls (n = 40) using a seed-based approach via PickAtlas and SPM12.

RESULTS

All PTSD patients showed extensive DL- and VL-PAG functional connectivity at rest with areas associated with emotional reactivity and defensive action as compared to controls (n = 40). Although all PTSD patients demonstrated DL-PAG functional connectivity with areas associated with initiation of active coping strategies and hyperarousal (e.g., dorsal anterior cingulate; anterior insula), only dissociative PTSD patients exhibited greater VL-PAG functional connectivity with brain regions linked to passive coping strategies and increased levels of depersonalization (e.g., temporoparietal junction; rolandic operculum).

CONCLUSIONS

These findings suggest greater defensive posturing in PTSD patients even at rest and demonstrate that those with the dissociative subtype show unique patterns of PAG functional connectivity when compared to those without the subtype. Taken together, these findings represent an important first step toward identifying neural and behavioral targets for therapeutic interventions that address defensive strategies in trauma-related disorders.

The Occurrence and Traumatic Impact of Sexual Revictimization in Newlywed Couples

The present study examines whether individuals with a history of child sexual abuse are at risk of sexual revictimization in marriage and, if so, whether these experiences are associated with increased trauma symptomatology. Two hundred heterosexual newlywed couples were recruited from marriage license records and completed self-report assessments of past sexual victimization and sexual coercion within the marital dyad. Actor-Partner Interdependence Models revealed that, compared to non-victims, women with a history of child sexual abuse (CSA) experienced more acts of sexual coercion by their husbands during the past year. Moreover, there was a significant interaction between CSA and sexual coercion such that, among women who experienced CSA, the relationship between marital revictimization and trauma symptoms was stronger. Findings suggest that, for women but not men, sexual revictimization may occur in the context of a new marriage, and these experiences are associated with increased trauma symptoms. These findings have implications for understanding female survivors' perceptions of risk, and are particularly concerning given the high degree of personal and legal commitment involved in marriage.

The relationship between sensory processing patterns, alexithymia, traumatic childhood experiences, and quality of life among patients with unipolar and bipolar disorders

Several studies documented the involvement of sensory perception in emotional processes. The long-term consequences of traumatic experiences and alexithymia have been demonstrated as well. However, the role of extreme sensory processing patterns, traumatic childhood experiences, and alexithymia has not been thoroughly examined in major affective disorders. The present study aimed to: (1) compare unipolar/bipolar patients with regard to their sensory processing patterns, alexithymia, childhood traumatic experiences and quality of life; (2) examine the correlations between sensory processing patterns and childhood traumatic experiences; (3) investigate the relative contribution of diagnostic groups (unipolar/bipolar), sensory processing patterns, alexithymia, and childhood traumatic experiences in predicting quality of life. The sample included 336 participants, 197 with unipolar and 139 with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI)-II, and Short Form 12 Health Survey version 2 (SF-12). Bipolar patients showed significantly higher physical neglect, emotional abuse, and emotional neglect compared with unipolar patients. Both in unipolar and bipolar groups, lower registration of sensory input as well as hypersensitivity correlated with enhanced childhood trauma events. Reduced sensory sensitivity accounted for 11% of the variance in physical health composite score (PCS) of SF-12 whereas reduced depression accounted for 8% of the variance in mental health composite score (MCS). Furthermore, elevated MCS was predicted by depression, physical and emotional neglect. Sensory processing patterns and childhood traumatic experiences may specifically characterize individuals with major affective disorders and play a role in the prediction of their quality of life.

Factorial validity of the Childhood Trauma Questionnaire in Italian psychiatric patients

Early adverse experiences are associated with neurobiological changes and these may underlie the increased risk of psychopathology. The Childhood Trauma Questionnaire (CTQ-SF) is the most commonly used instrument for assessing childhood maltreatment. Thus, the aim of our study was to investigate the factorial validity of an Italian version of the CTQ-SF in a sample of psychiatric inpatients by means of confirmatory and exploratory factor analyses. The sample was composed of 471 psychiatric in-patients and out-patients (206 males and 265 females) aged 16-80 years (mean age=34.4 years [SD=16.3]) consecutively admitted to two psychiatric departments. All patients were administered the Italian version of the CTQ-SF. We tested five different factor models which lacked good fit, while the exploratory factor analysis supported the adequacy of a solution with three factors (Emotional Neglect/Abuse, Sexual Abuse, Physical Neglect/Abuse). The three factors had satisfactory internal consistency (ordinal Cronbach alphas >0.90). Our study supports results from previous research indicating the lack of structural invariance of the CTQ-SF in cross-cultural adaptations of the test, and the fact that, when measuring different types of childhood maltreatment, the difference between abuse and neglect may be not valid.

Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa?

PURPOSE

The purpose of this study was to explore the association between specific forms of childhood abuse and neglect with lifetime suicide attempts in women with bulimia nervosa (BN).

METHODS

Two hundred and four women aged 18-65 (mean 25.6 years, SD 9.13) with full or subclinical BN were recruited in five US Midwestern communities and specialized eating disorder clinics. Participants completed questionnaires including the Childhood Trauma Questionnaire (CTQ) and self-reported whether they had ever had a lifetime suicide attempt. Logistic regression analyses were used to predict lifetime suicide attempts from each subscale of the CTQ.

RESULTS

Childhood emotional, physical, and sexual abuse were significantly associated with the presence of a lifetime suicide attempt in women with BN. Childhood emotional and physical neglect were not associated with suicide attempts.

CONCLUSIONS

Individuals with BN who have experienced childhood emotional and sexual abuse are at increased risk of a lifetime suicide attempt. Future research is needed to understand the mechanism to address in treatment and prevention efforts. It is important for clinicians to be aware of the potential increased risk of suicide in individuals with BN with a history of childhood abuse.

Lifetime stress accelerates epigenetic aging in an urban, African American cohort: relevance of glucocorticoid signaling

Background

Chronic psychological stress is associated with accelerated aging and increased risk for aging-related diseases, but the underlying molecular mechanisms are unclear.

Results

We examined the effect of lifetime stressors on a DNA methylation-based age predictor, epigenetic clock. After controlling for blood cell-type composition and lifestyle parameters, cumulative lifetime stress, but not childhood maltreatment or current stress alone, predicted accelerated epigenetic aging in an urban, African American cohort (n = 392). This effect was primarily driven by personal life stressors, was more pronounced with advancing age, and was blunted in individuals with higher childhood abuse exposure. Hypothesizing that these epigenetic effects could be mediated by glucocorticoid signaling, we found that a high number (n = 85) of epigenetic clock CpG sites were located within glucocorticoid response elements. We further examined the functional effects of glucocorticoids on epigenetic clock CpGs in an independent sample with genome-wide DNA methylation (n = 124) and gene expression data (n = 297) before and after exposure to the glucocorticoid receptor agonist dexamethasone. Dexamethasone induced dynamic changes in methylation in 31.2 % (110/353) of these CpGs and transcription in 81.7 % (139/170) of genes neighboring epigenetic clock CpGs. Disease enrichment analysis of these dexamethasone-regulated genes showed enriched association for aging-related diseases, including coronary artery disease, arteriosclerosis, and leukemias.

Conclusions

Cumulative lifetime stress may accelerate epigenetic aging, an effect that could be driven by glucocorticoid-induced epigenetic changes. These findings contribute to our understanding of mechanisms linking chronic stress with accelerated aging and heightened disease risk.

Electronic supplementary material

The online version of this article (doi:10.1186/s13059-015-0828-5) contains supplementary material, which is available to authorized users.

Interaction between SLC6A4 promoter variants and childhood trauma on the age at onset of bipolar disorders

Age at onset (AAO) of bipolar disorders (BD) could be influenced both by a repeat length polymorphism (5HTTLPR) in the promoter region of the serotonin transporter gene (SLC6A4) and exposure to childhood trauma. We assessed 308 euthymic patients with BD for the AAO of their first mood episode and childhood trauma. Patients were genotyped for the 5HTTLPR (long/short variant) and the rs25531. Genotypes were classified on functional significance (LL, LS, SS). A sample of 126 Brazilian euthymic patients with BD was used for replication. In the French sample, the correlation between AAO and trauma score was observed only among 'SS' homozygotes (p = 0.002) but not among 'L' allele carriers. A history of at least one trauma decreased the AAO only in 'SS' homozygotes (p = 0.001). These results remained significant after correction using FDR. Regression models suggested an interaction between emotional neglect and 'SS' genotype on the AAO (p = 0.009) and no further interaction with other trauma subtypes. Partial replication was obtained in the Brazilian sample, showing an interaction between emotional abuse and 'LS' genotype on the AAO (p = 0.02). In conclusion, an effect of childhood trauma on AAO of BD was observed only in patients who carry a specific stress responsiveness-related SLC6A4 promoter genotype.

Influence of Sex on Suicidal Phenotypes in Affective Disorder Patients with Traumatic Childhood Experiences

Objectives

In the current study, we aimed to investigate the impact of childhood trauma on suicidal behaviour phenotypes in a group of patients with diagnosed affective disorder (unipolar or bipolar affective disorder).

Patients and Methods

Patients with and without a history of childhood abuse, measured by Childhood Trauma Questionnaire (CTQ), were assessed to explore risks for suicidal behaviour (including suicide attempt, self-harm and non-suicidal self-injury). The tested sample consisted of 258 patients (111 males and 147 females, in-patients and out-patients at the Department of Psychiatry and Psychotherapy, Medical University of Vienna and University Hospital Tulln, Lower Austria). Psychiatric diagnoses were derived from the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) interview. In addition, patients were administered the Lifetime Parasuicidal Count (LPC), Suicidal Behaviour Questionnaire (SBQ-R), and Viennese Suicide Risk Assessment Scale (VISURIAS) questionnaires.

Results

In contrast to male suicide attempters, female suicide attempters showed both significantly higher total CTQ scores (p<0.001), and higher CTQ subscores (emotional, physical and sexual abuse, as well as emotional and physical neglect) in comparison to the non-suicidal control group. Besides, females with a history of self-harming behaviour (including suicidal intention) and Non-Suicidal-Self Injury (NSSI) had significantly higher CTQ total scores (p<0.001) than the control group.

Conclusion

These findings suggest gender differences in suicidal behaviour after being exposed to childhood trauma.

Childhood maltreatment increases the risk for visceral obesity

OBJECTIVE

The reports regarding the associations between childhood maltreatment (CM) and body fat composition remain heterogeneous in humans although they are indicated in preclinical studies. In addition, the effects of CM subtypes on different types of body fat are unclear. Thus, in this study, the associations between CM and its subtypes with body fat were determined and the potential pathways were explored.

METHODS

The participants were assessed for a history of CM by the Childhood Trauma Questionnaire and were divided into the CM group (with CM exposures) and non-CM group (without CM exposures). Body composition was measured by dual-energy X-ray absorptiometry. Salivary and blood samples were provided by the subjects.

RESULTS

Compared with the non-CM group, subjects with a history of CM had greater visceral fat mass (1,136 ± 160 vs. 836 ± 116 g, P < 0.05) but not total body fat, android fat, body mass index, or waist-to-hip ratio. In addition, subjects with CM had a blunted cortisol awakening response and elevated inflammatory factors. Correlation analysis indicated that CM subtypes had differential effects on visceral adiposity and cortisol awakening response.

CONCLUSIONS

It is suggested by our results that CM exposure is linked with increased visceral fat deposition, and the perturbation of the hypothalamic-pituitary-adrenal axis activity and activation of the immune system may be two potential pathways through which this relationship is explained.

Patterns of childhood abuse and neglect as predictors of treatment outcome in inpatient psychotherapy: a typological approach

BACKGROUND

Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome.

METHODS

742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake.

RESULTS

The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome.

CONCLUSION

The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

The associations among childhood maltreatment, "male depression" and suicide risk in psychiatric patients

In the current cross-sectional study, we aimed to investigate the presence and severity of "male" depressive symptoms and suicidal behaviors in psychiatric patients with and without a history of child abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), as well as to explore the associations among childhood maltreatment, "male depression" and suicide risk. The sample consisted of 163 consecutively admitted adult inpatients (80 men; 83 women). The patients were administered the CTQ, Gotland Male Depression Scale (GMDS), and Suicidal History Self-Rating Screening Scale (SHSS). Those with a moderate-severe childhood maltreatment history were more likely to be female (p<0.05) and reported more "male depression" (p<0.001) and suicidal behaviors (p<0.01) as compared to those not having or having a minimal history of child abuse and neglect. In the multivariate analysis, only the minimization/denial scale of the CTQ (odds ratio=0.31; p<0.001) and "male depression" (odds ratio=1.83; p<0.05) were independently associated with moderate/severe history of child maltreatment. The findings suggest that exposure to abuse and neglect as a child may increase the risk of subsequent symptoms of "male depression", which has been associated with higher suicidal risk.

Pathway from child sexual and physical abuse to risky sex among emerging adults: the role of trauma-related intrusions and alcohol problems

PURPOSE

Some evidence suggests that risk reduction programming for sexual risk behaviors (SRB) has been minimally effective, which emphasized the need for research on etiological and mechanistic factors that can be addressed in prevention and intervention programming. Childhood sexual and physical abuse have been linked with SRB among older adolescents and emerging adults; however, pathways to SRB remain unclear. This study adds to the literature by testing a model specifying that traumatic intrusions after early abuse may increase risk for alcohol problems, which in turn may increase the likelihood of engaging in various types of SRB.

METHODS

Participants were 1,169 racially diverse college students (72.9% female, 37.6% black/African-American, and 33.6% white) who completed anonymous questionnaires assessing child abuse, traumatic intrusions, alcohol problems, and sexual risk behavior.

RESULTS

The hypothesized path model specifying that traumatic intrusions and alcohol problems account for associations between child abuse and several aspects of SRB was a good fit for the data; however, for men, stronger associations emerged between physical abuse and traumatic intrusions and between traumatic intrusions and alcohol problems, whereas for women, alcohol problems were more strongly associated with intent to engage in risky sex.

CONCLUSIONS

Findings highlight the role of traumatic intrusions and alcohol problems in explaining paths from childhood abuse to SRB in emerging adulthood, and suggest that risk reduction programs may benefit from an integrated focus on traumatic intrusions, alcohol problems, and SRB for individuals with abuse experiences.

Posttraumatic stress disorder symptoms: a mechanism in the relationship between early sexual victimization and incapacitated/drug-or-alcohol-facilitated and forcible rape

Sexual assault occurring when the victim is unable to consent or resist due to the use or administration of alcohol or drugs (i.e., incapacitated/drug-or-alcohol facilitated rape; IR/DAFR) is a particularly prevalent form of victimization experienced by college women. By definition, substance use precedes IR/DAFR; however, few studies have examined other potential risk factors for IR/DAFR that may be unique from those associated with forcible rape (FR; i.e., sexual assault occurring due to threats or physical restraint). The present investigation tested a model of risk for IR/DAFR and FR suggesting that child or adolescent sexual abuse (CASA) leads to posttraumatic stress disorder (PTSD) symptoms, which in turn increase the likelihood of IR/DAFR, but not FR. Results revealed full mediation for PTSD hyperarousal symptoms in the pathway between CASA and IR/DAFR, and partial mediation for hyperarousal symptoms in the pathway between CASA and FR. Theoretical and clinical implications are discussed.

Lifetime sexual victimization and poor risk perception: does emotion dysregulation account for the links?

The present study examined whether and which facets of emotion dysregulation serve an intervening role in the association between prior victimization and risk perception in an analogue sexual assault vignette. Participants were 714 university women who completed self-report measures of sexual victimization, emotion dysregulation, and a computer-administered written vignette of a college party scene that culminates in acquaintance rape. Approximately 42% of the sample reported lifetime sexual victimization during childhood, adolescence, or adulthood. Two individual aspects of emotion dysregulation, limited access to emotion regulation strategies and impulse control difficulties, mediated the association between lifetime victimization and leaving the scenario later. Findings suggest the importance of emotion dysregulation in predicting risk perception among victims and of improving victims' emotion regulation skills in revictimization risk reduction interventions.

Psychological maltreatment in relation to substance use problem severity among youth

OBJECTIVES

Research has demonstrated that experiences of childhood maltreatment are prevalent in the life histories of youth with substance use problems; however, most of this research has focused on sexual or physical abuse. The purpose of the current study was to extend the scope of previous investigations to include psychological maltreatment experiences, examining the extent to which emotional abuse and emotional neglect predict substance use problem severity among youth. The current study also sought to examine whether a cumulative model fit the data, in which the experience of multiple forms of maltreatment would be related most strongly to severity of substance use problems, or whether there was a distinct effect of psychological maltreatment.

METHODS

Data were collected through self-report questionnaires from 216 youth (144 males, 72 females) entering an outpatient treatment program for youth with substance use concerns.

RESULTS

Results indicated that, when considering all forms of abuse together, only emotional abuse and emotional neglect emerged as significant predictors of substance use problem severity. Furthermore, the association between psychological maltreatment and substance use problem severity was unaltered by the consideration of concurrent experiences of interpersonal violence.

CONCLUSIONS

The results of the current study are consistent with those of a body of research describing the detrimental effects of psychological maltreatment. The findings have potential implications for the development and provision of trauma-informed youth substance use treatment services. The findings suggest that attending to the sequelae of psychological maltreatment may be important in assisting these youth in achieving successful treatment outcomes.

Victimization and sexual risk behavior in young, HIV positive women: exploration of mediators

In this study we explore associations between child and adult victimization and sexual risk behavior in 118 young, HIV positive women. Prior research has demonstrated associations between victimization and engagement in sexual risk behavior. Victimization sequelae can include disrupted assertiveness and communication, as well as increased association with risky partners, both of which are also linked with engagement in sexual risk behavior. Thus, we propose a model wherein victimization is linked to sexual risk behavior through two mediating pathways, sexual communication and affiliation with risky partners. We also examine the moderating effects of the presence of an anxiety or depressive disorder on the path from child to adult victimization. Results suggested that adult victimization was associated with unprotected sex with a main partner; however, this association was mediated by less sexual communication and having a risky partner. Trends toward significance were found for depression and anxiety as a moderator of the relationship between child and adult victimization. Child victimization did not have direct effects on unprotected sex. Implications for secondary prevention of HIV and healthy intimate relationships are discussed.

Reliability and validity of the korean version of the childhood trauma questionnaire-short form for psychiatric outpatients

OBJECTIVE

The Childhood Trauma Questionnaire (CTQ) is perhaps the most widely used and well-studied retrospective measure of childhood abuse or neglect. This study tested the initial reliability and validity of a Korean translation of the Childhood Trauma Questionnaire (CTQ-K) among non-psychotic psychiatric outpatients.

METHODS

The CTQ-K was administered to a total of 163 non-psychotic psychiatric outpatients at a university-affiliated training hospital. Internal consistency, four-week test-retest reliability, and validity were calculated. A portion of the participants (n=65) also completed the Trauma Assessment Questionnaire (TAQ), the Impact of Events Scale-Revised, and the Dissociative Experiences Scale-Taxon.

RESULTS

Four-week test-retest reliability was high (r=0.87) and internal consistency was good (Cronbach's α=0.88). Each type of childhood trauma was significantly correlated with the corresponding subscale of the TAQ, thus confirming its concurrent validity. In addition, the CTQ-K total score was positively related to post-traumatic symptoms and pathological dissociation, demonstrating the convergent validity of the scale. The CTQ-K was also negatively correlated with the competence and safety subscale of the TAQ, confirming discriminant validity. Additionally, we confirmed the factorial validity by identifying a five-factor structure that explained 64% of the total variance.

CONCLUSION

Our study indicates that the CTQ-K is a measure of psychometric soundness that can be used to assess childhood abuse or neglect in Korean patients. It also supports the cross-cultural equivalence of the scale.

Structural equation modeling of repeated retrospective reports of childhood maltreatment

The present study examined errors of reporting, including unreliability and recall bias, in retrospective reports of childhood maltreatment. Data were gathered on retrospective reports of childhood sexual and physical abuse and current mental health in a birth cohort of over 980 participants studied at ages 18 and 21. A structural equation model was developed to estimate the contributions of test unreliability and recall bias to reporting variation. Retrospective abuse reports were of modest test-retest reliability (r(tt)  = 0.50 approximately). Recall bias accounted for <1% of report variance. As a consequence the observed correlations between maltreatment and mental health closely approximated the corresponding estimated true correlations. The results of the study suggested that, for this cohort, errors of measurement in reports of childhood maltreatment did not pose a significant threat to study validity.

Child abuse, early maladaptive schemas, and risky sexual behavior in college women

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse-risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual, physical, and emotional, and assessed early maladaptive schemas within two domains: Disconnection/rejection and Other-Directedness. Disconnection/rejection schemas fully mediated the relation between child emotional abuse and number of sexual partners and partially mediated the relationship for sexual and physical abuse. However, when frequency of specific risky sexual acts (e.g., sex without contraception) was examined in the previous six months, only abandonment was a partial mediator. Implications for intervention and future research are discussed.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Understanding social support's role in the relationship between maltreatment and depression in youth with foster care experience

This study investigated whether more complex maltreatment experiences predicted higher levels of depressive symptomatology for young adults and examined the role of social support during late adolescence in that association. Specifically, the study tested whether social support had a direct effect on depression and whether it mediated and/or moderated the relationship between self-reported maltreatment and depression in a sample of 513 youth exiting the child welfare system. Indices of maltreatment types (neglect and physical, sexual, psychological abuse) experienced during two periods (precare and during-care) were used in conjunction with a measure of perceived social support (reflecting support availability and social network sufficiency) in negative binomial regression models predicting depressive symptoms. Both precare and during-care maltreatment were associated with depressive symptoms as a young adult. Social support had a direct effect on depressive symptoms as well as moderation and partial mediation effects on the relationship between maltreatment and depression. Social support's buffering effect was stronger for those experiencing fewer types of maltreatment. This buffering effect appears to diminish as maltreatment histories become more complex.

Emotion dysregulation and risky sexual behavior in revictimization

OBJECTIVE

The current study examined emotion dysregulation as a mechanism underlying risky sexual behavior and sexual revictimization among adult victims of child sexual abuse (CSA) and child physical abuse (CPA).

METHODS

Participants were 752 college women. Victimization history, emotion dysregulation, and risky sexual behavior were assessed with anonymous, self-report surveys utilizing a cross-sectional design.

RESULTS

Approximately 6.3% of participants reported CSA, 25.5% reported CPA, and 17.8% reported rape during adolescence or adulthood. CSA and CPA were associated with increased risk for adolescent/adult rape; 29.8% of CSA victims and 24.3% of CPA victims were revictimized. Path analytic models tested hypothesized relationships among child abuse, emotion dysregulation, adolescent/adult rape and three forms of risky sexual behavior (e.g., failure to use condoms, contraception, or having sex with someone under the influence of alcohol/drugs), including frequency of risky sexual behavior with a regular dating partner, with a stranger, and lifetime number of intercourse partners. Emotion dysregulation mediated revictimization for both CSA and CPA. Emotion dysregulation also predicted lifetime number of sexual partners and frequency of risky sex with a stranger, but not frequency of risky sex with a regular dating partner.

CONCLUSIONS

Findings suggest that emotion dysregulation is a distal predictor, and risky sex, particularly with lesser known partners, is a proximal predictor of sexual revictimization. Because emotion dysregulation also maintained a significant direct path to revictimization, risky sexual behavior appears to be one of several proximal risk factors for revictimization.

PRACTICE IMPLICATIONS

Findings confirm that emotion dysregulation is a critical pathway to more proximal risk factors such as risky sexual behavior, and suggest that clinical interventions aimed at improving emotion dysregulation may help reduce risky sexual behavior and risk for revictimization.

Questioning the role of abuse in behavioral spells and epilepsy

Past sexual trauma is frequently linked to the development of behavioral spells, present among 30% of patients admitted for video/EEG monitoring. Current attempts to verify and explore mechanisms in this reported association revealed that patients with epilepsy (n=58) and those with behavioral spells (n=38) did not differ in their self-report of past sexual trauma (among approximately 38% in each group). Ninety percent (90%) of men with behavioral spells endorsed past physical abuse, however, compared with 45% of men with epilepsy, and 40% of men with spells likely met current criteria for posttraumatic stress disorder. Among all patients, the presence of past physical, but not sexual, abuse positively predicted the diagnosis of spells rather than epilepsy. Current findings do not support a preponderance of sexual trauma in behavioral spells, yet within the subset of men with spells, greater exposure to physical abuse and current symptoms of posttraumatic stress disorder may be important etiological and sustaining factors.

Going Along With It: Sexually Coercive Partner Behavior Predicts Dating Women’s Compliance With Unwanted Sex

Sexual compliance involves willing consent to unwanted sex despite a lack of sexual desire.The authors hypothesized that compliance would be significantly more common among women with sexually coercive partners because compliance allows women to bypass possible coercion. Undergraduate women in heterosexual relationships ( N = 76) responded to self-report measures of partner sexually coercive behavior at baseline and sexual compliance 6 weeks later. As expected, reports of partner coercive behavior at Time 1 predicted women’s willing consent to unwanted sex at Time 2. Most compliant women consented to unwanted sex after learning their partners may coerce them if they refuse.

Development and initial psychometric properties of the Computer Assisted Maltreatment Inventory (CAMI): a comprehensive self-report measure of child maltreatment history

OBJECTIVES

The present study reports on the development and initial psychometric properties of the Computer Assisted Maltreatment Inventory (CAMI), a web-based self-report measure of child maltreatment history, including sexual and physical abuse, exposure to interparental violence, psychological abuse, and neglect.

METHODS

The CAMI was administered to a geographically diverse sample of college students (N=1398). For validation purposes, participants also completed a widely used measure of maltreatment (Childhood Trauma Questionnaire) as well as measures of social desirability. To examine test-retest reliability, a subset of participants (n=283) completed the CAMI a second time 2-4 weeks after the initial administration.

RESULTS

Short-term test-retest reliability of the CAMI subscales was good to strong, as was internal consistency on applicable scales. Criterion-related validity of the CAMI's composite abuse severity scores was supported through predicted discriminative correlations with subscales of the CTQ. The CAMI subscales showed comparable or weaker associations with measures of social desirability than did the CTQ. Although both measures were more strongly associated with a need for approval than other aspects of social desirability, these correlations were still rather low in magnitude and in a range typical of many clinical measures.

CONCLUSIONS

The present findings as well as the rich descriptive data and flexibility offered by computer administration suggest that the CAMI is a promising instrument for the comprehensive assessment of maltreatment history from adults.

Severity of Child Sexual Abuse and Revictimization: The Mediating Role of Coping and Trauma Symptoms

Child sexual abuse (CSA) has consistently been associated with the use of avoidant coping; these coping methods have been associated with increased trauma symptoms, which have, in turn, been linked to increased risk for adult sexual revictimization. Given these previous findings, the purpose of the current study was to test a model that conceptualized the relationships among these variables. Specifically, CSA severity was conceptualized as leading to the use of avoidant coping, which was proposed to lead to maintenance of trauma symptoms, which would, in turn, impact severity of revictimization indirectly. This comprehensive model was tested in a cross-sectional study of a large, geographically diverse sample of college women. Participants were 99 female undergraduates classified as having experienced CSA who completed measures of abuse history, coping style, current levels of trauma symptoms, and adult sexual revictimization. Multivariate path analysis indicated that the data fit the hypothesized model for verbally coercive, but not physically aggressive, revictimization. Specifically, increased CSA severity was associated with the use of avoidant coping, which, in turn, predicted greater levels of trauma symptomatology and severity of sexual coercion in adulthood. Although cross-sectional in nature, findings from this study suggest that coping strategies and trauma symptoms may represent modifiable factors that place women at increased risk for verbally coercive sexual revictimization.